Biopsychosocial correlates of lifetime major depression in a multiple sclerosis population.

The objective of this paper was to evaluate the lifetime and point prevalence of major depression in a population-based Multiple Sclerosis (MS) clinic sample, and to describe associations between selected biopsychosocial variables and the prevalence of lifetime major depression in this sample. Subjects who had participated in an earlier study were re-contacted for additional data collection. Eighty-three per cent (n=136) of those eligible consented to participate. Each subject completed the Composite International Diagnostic Interview (CIDI) and an interviewer-administered questionnaire evaluating a series of biopsychosocial variables. The lifetime prevalence of major depression in this sample was 22.8%, somewhat lower than previous estimates in MS clinic populations. Women, those under 35, and those with a family history of major depression had a higher prevalence. Also, subjects reporting high levels of stress and heavy ingestion of caffeine (>400 mg) had a higher prevalence of major depression. As this was a cross-sectional analysis, the direction of causal effect for the observed associations could not be determined. By identifying variables that are associated with lifetime major depression, these data generate hypotheses for future prospective studies. Such studies will be needed to further understand the etiology of depressive disorders in MS.

Major depression and quality of life in individuals with multiple sclerosis.

OBJECTIVE: To compare the Quality of Life (QOL) of multiple sclerosis (MS) patients with and without lifetime major depression. METHOD: Data on 136 MS subjects sampled from the University of Calgary MS Clinic were collected. The WHO's Composite International Diagnostic Interview (CIDI) was used to diagnose lifetime major depression. The MSQOL-54 was administered to evaluate QOL of the subjects. RESULTS: Thirty one (22.8 percent) of the 136 MS subjects had lifetime major depression, However, only 6 of these had a current episode at the time of data collection. MS patients with lifetime major depression had significantly lower MSQOL-54 scores in the QOL domains of Energy, Mental Health, Cognitive Function, General Quality of Life, Sexual Function, and Role Limitation-Emotional than the MS patients without lifetime major depression. CONCLUSIONS: Lifetime major depression may have a substantial impact on the QOL of people with MS. Alternatively, MS patients with poor QOL may be at greater risk of major depression.

Music therapy as a treatment method for improving respiratory muscle strength in patients with advanced multiple sclerosis: a pilot study.

Respiratory muscle weakness, predominantly of the expiratory muscles, is characteristic of individuals with advanced multiple sclerosis and can result in difficulty in clearing secretions and repeated episodes of pneumonia. This pilot study evaluated the effectiveness of music therapy in strengthening respiratory muscles through an emphasis on diaphragmatic breathing and coordination of breath and speech. Twenty patients were randomly assigned to one of two groups: one that received music therapy or one that attended music appreciation sessions. Participants' inspiratory and expiratory muscle strength was measured by testing mouth pressure before and after the intervention. The experimental group showed some improvement in terms of expiratory muscle strength, in contrast to the control group, which showed deterioration. The results were not statistically significant, however. Patients in both groups exhibited considerable weakness in their expiratory muscles, and results for 79% of the participants were below 30% of the predicted values. Variability, a major confounding factor that resulted in reduced statistical power, led the investigators to suggest an intercenter collaboration to amass sufficient numbers of patients for a future study. Early manifestation of respiratory muscle weakness warrants inclusion of respiratory muscle testing in examination protocols and early intervention efforts.

Development of a disease-specific health-related quality of life questionnaire for sleep apnea.

The Calgary Sleep Apnea Quality of Life Index (SAQLI) was developed to record key elements of the disease that are important to patients. All items felt to influence the quality of life of these patients were identified. Final questionnaire items were selected by interviewing 113 patients with sleep apnea and 50 snorers who rated each item on whether it was a problem and the importance of it to their overall quality of life. Items for the final questionnaire were selected based on the rank order of the frequency ximportance product. The rank ordering was similar across strata of disease severity and between sexes. The Calgary SAQLI has 35 questions organized into four domains: daily functioning, social interactions, emotional functioning, and symptoms. A fifth domain, treatment-related symptoms, can be added for clinical intervention trials to record the possible negative impacts of treatment. The SAQLI has a high degree of internal consistency, face validity as judged by content experts and patients, and construct validity as shown by its positive correlations with the SF-36 and the improvement in scores in patients successfully completing a 4-wk trial of continuous positive airway pressure. It includes items shown to be important to patients with sleep apnea and is designed as a measure of outcome in clinical trials in sleep apnea. Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionnaire for sleep apnea.

Research or quality improvement?. Making the decision.

Deciding if a project is one of research or quality improvement is a dilemma frequently faced by nursing administrators. Guidelines have been established to help administrators and practitioners overcome this dilemma and, at the same time, consider the rights and responsibilities of the patient, the hospital, and the investigator.